Quality Medical Coder

Abilis Health Plan

Abilis Health Plan (formerly Signature Advantage Plan) is seeking a detail-oriented and technically skilled Quality Medical Coder to support our clinical operations. The Part Time Coder is responsible for reviewing and assigning accurate medical codes for diagnoses, procedures, and services performed by health care providers. The coder ensures that coding meets compliance standards, payer specific guidelines, and federal regulations to support accurate reimbursement, reduce claim denials, and other task as needed. This role involves coding and data management task related to clinical documentation, electronic health records, and operational reporting. The ideal candidate will have experience in medical coding, data integrity, and working with healthcare systems.

The Quality Medical Coder is responsible for reviewing and assigning accurate medical codes for diagnoses, procedures, other services performed by healthcare providers by applying appropriate coding standards.
• The coder will assist with audits and ongoing education, ensures accuracy and compliance with federal regulations and payer specific guidelines to support accurate reimbursement and reduce claim denials.
• Assign ICD 10-CM, CPT, and HCPCS codes for professional and or facility services.
• Review medical documentation to ensure accuracy, completeness, and compliance with official coding guidelines.
• Collaborate and query with clinical staff/providers when documentation is unclear or incomplete.
• Assist with data extraction and reporting for operational and compliance needs.
• Collaborate with Quality Assurance and others to resolve coding related to denials and trends.
• Support process improvements and best practices to increase coding efficiency and reduce rework.
• Maintain confidentiality and security of patient information in accordance with HIPAA.
  

• Certification in medical coding (e.g., CPC, CCS, or equivalent) preferred.
• Minimum 2+ years of experience in clinical coding or healthcare data management.
• Experience with working with Electronic Health Record systems and clinical documentation workflows.
• Strong attention to detail and knowledge of ICD 10-CM, CPT, and HCPCS Level II coding systems
• Knowledge of Hierarchical Condition Categories (HCCs) and Medicare Risk Adjustment methodologies.
• Experience with HEDIS coding and quality measure abstraction.
• Familiarity with RADV audits and documentation requirements.
• Understanding of risk adjustment data validation processes and payer-specific coding guidelines.
• Strong understanding of regulatory requirements related to coding.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Ability to read and interpret documents, identify areas of coding gaps.
• Ability to speak effectively with providers and collective team.
• Ability to work independently and as a part of a collaborative team
• Travel up to 25%